Maxwell Air Force Base

This paper reviews studies on the basic principles of biostimulation of wound healing by various low-energy lasers. It looks at the mechanism of action of biostimulation as well as the laser's effect on cell proliferation, collagen synthesis, and would healing.

As the construct of moral injury has gained increased conceptual and empirical attention among military personnel and veterans, preliminary attempts to operationalize and measure the construct have emerged. One such measure is the Moral Injury Event Scale (MIES). The aim of the current study was to further evaluate the MIES's psychometric properties in two military samples: a clinical sample of Air Force personnel and a nonclinical sample of Army National Guard personnel. Exploratory and confirmatory factor analyses across both samples supported a three-factor solution: transgressions by others, transgressions by self, and betrayal. Transgressions-Others was most strongly associated with posttraumatic stress; Transgressions-Self was most strongly associated with hopelessness, pessimism, and anger; and Betrayal was most strongly associated with posttraumatic stress and anger. Results support the construct validity of the MIES, although areas for improvement are indicated and discussed.

Moral injury entails emotional distress associated with perceived violations of one’s moral code and has been proposed to be a possible contributor to self-injurious thoughts and behaviors (SITB) among military personnel. Three dimensions of moral injury have previously been empirically derived: transgressions committed by others (Transgressions-Others), transgressions committed by oneself (Transgressions-Self), and perceived betrayal by others (Betrayal). The current study examined the relationship of these dimensions of moral injury with SITB in a clinical sample of 151 active duty military personnel. Transgressions-Other and Transgressions-Self were significantly higher among personnel with a history of suicide attempt relative to history of suicidal ideation and no suicidality (Hedge’s g’s .64). Transgressions-Self was associated with significantly more severe suicidal ideation during the past week (p .018).

BACKGROUND: Increased suicide risk among US military personnel is a growing concern. Research has linked trauma exposure, including exposure to combat-related injuries, death, and atrocities to suicidal ideation among combat veterans. Guilt (feeling bad about what you did to another) and shame (feeling bad about who you are) have been proposed as potential contributors to suicidal ideation among military personnel, but have not yet received much empirical attention. METHODS: Sixty-nine active duty military personnel receiving outpatient mental health treatment at a military clinic completed self-report symptom measures of guilt, shame, depression, posttraumatic stress disorder, and suicidal ideation while engaged in treatment. Generalized linear regression modeling was utilized to test the association of guilt and shame with suicidal ideation. RESULTS: Mean levels of guilt and shame were significantly higher among military personnel with a history of suicidal ideation. Guilt (B = 0.203, SE = .046, P < .001) and shame (B = 0.111, SE = .037, P = .002) were independently associated with severity of current suicidal ideation above and beyond the effects of depression, PTSD symptoms, and the depression-by-PTSD interaction, and fully mediated the relationships of depression and PTSD symptom severity with suicidal ideation. When considered simultaneously, only guilt (B = 0.167, SE = .053, P = .001) was significantly associated with increased suicidal ideation. CONCLUSIONS: Guilt and shame are associated with increased severity of suicidal ideation in military mental health outpatients. Guilt has a particularly strong relationship with suicidal ideation.

Rising suicide rates are an increasing concern among military personnel. The interpersonal-psychological theory of suicide proposes that three necessary factors are needed to die by suicide: feelings that one does not belong with other people, feelings that one is a burden on others or society, and an acquired capability to overcome the fear and pain associated with suicide. The current study tests the theory's proposal that acquired capability may be particularly influenced by military experience, because combat exposure may cause habituation to fear of painful experiences such as suicide. Utilizing clinical and nonclinical samples of military personnel deployed to Iraq, results of the current study indicate that a greater range of combat experiences predicts acquired capability above and beyond depression and post-traumatic stress disorder symptoms, previous suicidality, and other common risk factors for suicide. Combat experiences did not, however, predict perceived burdensomeness or thwarted belongingness. The authors discuss how combat experiences might serve as a mechanism for elevating suicide risk and implications for clinical interventions and suicide prevention efforts.

Blast-related head injuries are one of the most prevalent injuries among military personnel deployed in service of Operation Iraqi Freedom. Although several studies have evaluated symptoms after blast injury in military personnel, few studies compared them to nonblast injuries or measured symptoms within the acute stage after traumatic brain injury (TBI). Knowledge of acute symptoms will help deployed clinicians make important decisions regarding recommendations for treatment and return to duty. Furthermore, differences more apparent during the acute stage might suggest important predictors of the long-term trajectory of recovery. This study evaluated concussive, psychological, and cognitive symptoms in military personnel and civilian contractors (N = 82) diagnosed with mild TBI (mTBI) at a combat support hospital in Iraq. Participants completed a clinical interview, the Automated Neuropsychological Assessment Metric (ANAM), PTSD Checklist-Military Version (PCL-M), Behavioral Health Measure (BHM), and Insomnia Severity Index (ISI) within 72 hr of injury. Results suggest that there are few differences in concussive symptoms, psychological symptoms, and neurocognitive performance between blast and nonblast mTBIs, although clinically significant impairment in cognitive reaction time for both blast and nonblast groups is observed. Reductions in ANAM accuracy were related to duration of loss of consciousness, not injury mechanism.

Bartonella (Rochalimaea) henselae causes a variety of diseases, including bacillary angiomatosis, peliosis hepatis, lymphadenitis, aseptic meningitis with bacteremia, and cat-scratch disease (CSD). Cases of B. henselae-related disease were collected from September 1991 through November 1993. Patients with suspected CSD, unexplained fever and lymphadenitis, or suspected B. henselae infection who were seen in the Infectious Diseases Clinic at Wilford Hall Medical Center (Lackland Air Force Base, TX) underwent physical and laboratory examinations. In addition to three previously described cases, 23 patients with R. henselae-related infection were identified. The patients included 19 immunocompetent individuals presenting with lymphadenitis (11), stellate neuroretinitis (5), Parinaud's oculoglandular syndrome with retinitis (1), chronic fatigue syndrome-like disease (1), and microbiologically proven adenitis without the presence of immunofluorescent antibodies to B. henselae (1) and four patients infected with human immunodeficiency virus type 1 presenting with isolated lymphadenitis (1), diffuse upper-extremity adenitis (1), neuroretinitis (1), and aseptic meningitis (1). A couple with neuroretinitis and their pet cat, a persistently fatigued patient, and a patient with Parinaud's oculoglandular syndrome were shown to have bacteremia. Tissue cultures were positive for B. henselae in three recent cases of adenitis. Twenty-two patients were exposed to cats. This series further demonstrates the similarities between B. henselae-related diseases and CSD and identifies several new syndromes due to B. henselae.

We describe 2 hospitalized patients with confirmed coronavirus 19 (COVID-19) infection in whom brain imaging showed hemorrhagic posterior reversible encephalopathy syndrome, and we discuss the possible reasons for these findings and their relationship to the infection.

The European and American literatures on interest groups developed largely separately in previous decades. Europeans were more commonly rooted in studies of policy systems and Americans more concerned with precise tactics of lobbying or the membership calculus following from the work of Mancur Olson. Recent developments suggest that the literatures have begun to be much more closely aligned. We focus on three major points of convergence. First is the impact of governmental structures on the development of national interest group systems. Using examples from the US and the EU, we discuss the co-evolution of groups and the state. Looking both over time and across issue domains, groups are more active when and where the state is more active. Second, we look at the impact of government structures on the locus of advocacy. Originally explored in the US context, multi-level governance structures in European settings have led to consideration of the concept of venue-shopping. Finally, we discuss how groups in both systems adjust their lobbying strategies to their political context. Our review suggests that the study of groups, long divided by different perspectives may begin to benefit from substantially more convergence of research interests.

Understanding Modern Warfare has established itself as the leading introduction to the issues, ideas, concepts and context necessary to understand the theory and conduct of warfare in the twentieth and twenty-first centuries. It is an invaluable text for military professionals and students of military history. Key features include: incisive coverage of the debates surrounding contemporary and future warfare; accessible, yet sophisticated, discussion across the land, sea, and air environments; and coverage of contemporary topics such as drones, cyber warfare, and hybrid warfare. The book makes extensive use of text boxes to explain key concepts and to reference extended examples, and it includes annotated guides to further reading and key questions to promote the reader's further thinking. This second edition has been fully revised and updated to take into account new debates and recent events in Syria, Iraq and Ukraine, and it has also been restructured to further improve its usefulness as a teaching tool.

Purpose To provide two possible approaches for enhancing organizational culture awareness and promote cultural change in public sector organization. These approaches include training and leading by example. Design/methodology/approach Literature outlining fundamental aspects of organizational culture is summarized, serving as a foundation for reviewing the potential value of training as a method for enhancing public managers' awareness of organizational culture. This is followed by an illustrated example of how the culture was changed in major department of a public organization through leading by example. Findings Training and leading by example can serve as effective methodologies for promoting culture awareness and brining about culture change in organizations. Practical implications The article highlights some interesting similarities and differences between cultures in public organizations and cultures in private sector organizations. The differences, in particular, reinforce the importance of training and leading by example to guide public sector employees through the complex dynamics often embodied within culture transformations in organizations. Originality/value While there are some important similarities between cultures of private sector and public sector organizations, the differences existing in public sector organization cultures create unique challenges for managers trying to evoke change. The article provides a unique perspective on applying training and leading by example to the context of public sector organizational culture.

PURPOSE: Evidence indicates that research participants often do not fully understand the studies for which they have volunteered. The aim of this systematic review was to examine the relationship between the process of obtaining informed consent for research and participant comprehension and satisfaction with the research. DESIGN: Systematic review of published research on informed consent and participant comprehension of research for which they volunteer using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement as a guide. METHODS: PubMed, Cumulative Index for Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trails, and Cochrane Database of Systematic Reviews were used to search the literature for studies meeting the following inclusion criteria: (a) published between January 1, 2006, and December 31, 2013, (b) interventional or descriptive quantitative design, (c) published in a peer-reviewed journal, (d) written in English, and (e) assessed participant comprehension or satisfaction with the research process. Studies were assessed for quality using seven indicators: sampling method, use of controls or comparison groups, response rate, description of intervention, description of outcome, statistical method, and health literacy assessment. FINDINGS: Of 176 studies identified, 27 met inclusion criteria: 13 (48%) were randomized interventional designs and 14 (52%) were descriptive. Three categories of studies included projects assessing (a) enhanced consent process or form, (b) multimedia methods, and (c) education to improve participant understanding. Most (78%) used investigator-developed tools to assess participant comprehension, did not assess participant health literacy (74%), or did not assess the readability level of the consent form (89%). Researchers found participants lacked basic understanding of research elements: randomization, placebo, risks, and therapeutic misconception. CONCLUSIONS: Findings indicate (a) inconsistent assessment of participant reading or health literacy level, (b) measurement variation associated with use of nonstandardized tools, and (c) continued therapeutic misconception and lack of understanding among research participants of randomization, placebo, benefit, and risk. While the Agency for Healthcare and Quality and National Quality Forum have published informed consent and authorization toolkits, previously published validated tools are underutilized. CLINICAL RELEVANCE: Informed consent requires the assessment of health literacy, reading level, and comprehension of research participants using validated assessment tools and methods.

Despite considerable efforts on the part of the Department of Defense, Department of Veterans Affairs, andthe wider mental health community, mental health stigma continues to be a significant barrier to seeking helpbyservicemembers,highlightingtheneedfornewermodesofthought.Asignificantfactorcontributingtothisstigma is the fundamental difference between traditional mental health approaches and the warrior culture. Asa mental health prevention initiative, the Defender’s Edge (DEFED) program was specifically developed tofit within the United States Air Force Security Forces (SF) charged with ground combat operations whiledeployed to Iraq. DEFED adopted a strengths-based philosophy and integrated a psychologist into the SFculture. Evaluative feedback from 192 program participants is presented, demonstrating high programmaticacceptability and feasibility suggestive of success in circumventing mental health stigma.Keywords: mental health stigma, military, OEF/OIF, deployment

Abstract This paper considers the problem of prediction in a panel data regression model with spatial autocorrelation in the context of a simple demand equation for liquor. This is based on a panel of 43 states over the period 1965–1994. The spatial autocorrelation due to neighbouring states and the individual heterogeneity across states is taken explicitly into account. We compare the performance of several predictors of the states’ demand for liquor for 1 year and 5 years ahead. The estimators whose predictions are compared include OLS, fixed effects ignoring spatial correlation, fixed effects with spatial correlation, random-effects GLS estimator ignoring spatial correlation and random-effects estimator accounting for the spatial correlation. Based on RMSE forecast performance, estimators that take into account spatial correlation and heterogeneity across the states perform the best for forecasts 1 year ahead. However, for forecasts 2–5 years ahead, estimators that take into account the heterogeneity across the states yield the best forecasts.

Estimates of the atmospheric temperature changes due to a doubling of CO2 concentrations have been with a static radiative flux model. They yield temperature changes >0.25 K. It appears that the much larger changes predicted by other models arise from additional water vapor evaporated into the atmosphere and not from the CO2 itself.

The efficacy of three group process variables—group potency, social cohesion, and team-member exchange—in explaining team performance was examined for 648 military officers working in 50 self-managed teams over a 5-week period. Team performance was assessed on two objective criteria (mental task performance and physical task performance) and one subjective criterion (commander team performance ratings). Each of the group process variables was related to at least one aspect of team performance. Of the three group process variables, group potency exhibited the greatest predictive efficacy as it explained unique variance in team performance over that accounted for by both social cohesion and team-member exchange.

There is a clear relationship between suicide risk and chronic pain conditions. However, the exact nature of this link has been poorly understood, with risk attribution often limited to comorbid depression. Perceived burdensomeness has already been confirmed as a risk factor for suicidal ideation (SI) and suicide attempt in the general population. Self-perceived burden, studied among medically and terminally ill medical populations, has begun to receive a great deal of attention as a suicide risk factor. However, this risk has not been considered in an outpatient chronic pain population, a group likely to experience perceived burdensomeness as a particular problem. Guidelines recommend routine suicide risk screening in medical settings, but many questionnaires are time-consuming and do not allow for the assessment of the presence of newly identified risk constructs, such as perceived burdensomeness. This retrospective study examined the relationship between depression, perceived burdensomeness, and SI in a patient sample seeking behavioral treatment for chronic pain management. A logistic regression model was developed, with preliminary results indicating perceived burdensomeness was the sole predictor of SI, even in the presence of other well-established risk factors such as age, gender, depressive symptoms, and pain severity. Findings highlight the potential utility of a single-item screening question in routine clinical care as an incrementally superior predictor of SI in a chronic pain population.

Journal Article Status Congruency as a Variable in Small Group Performance Get access Stuart Adams Stuart Adams Human Resources Research Institute, Maxwell Air Force Base, Alabama Search for other works by this author on: Oxford Academic Google Scholar Social Forces, Volume 32, Issue 1, October 1953, Pages 16–22, https://doi.org/10.2307/2572852 Published: 01 October 1953

The primary aim of the current study was to obtain information about the longitudinal clinical functioning of primary care patients who had received care from behavioral health consultants (BHCs) integrated into a large family medicine clinic. Global mental health functioning was measured with the 20-item self-report Behavioral Health Measure (BHM), which was completed by patients at all appointments with the BHC. The BHM was then mailed to 664 patients 1.5 to 3 years after receipt of intervention from BHCs in primary care, of which 70 (10.5%) were completed and returned (62.9% female; mean age 43.1 ± 12.7 years; 48.6% Caucasian, 12.9% African American, 21.4% Hispanic/Latino, 2.9% Asian/Pacific Islander, 10.0% Other, 4.3% no response). Mixed effects modeling revealed that patients improved from their first to last BHC appointment, with gains being maintained an average of 2 years after intervention. Patterns of results remained significant even when accounting for the receipt of additional mental health treatment subsequent to BHC intervention. Findings suggest that clinical gains achieved by this subset of primary care patients that were associated with brief BHC intervention were maintained approximately 2 years after the final appointment.

OBJECTIVE: To model typical trajectories for improvement among patients treated in an integrated primary care behavioral health service, multilevel models were used to explore the relationship between baseline mental health impairment level and eventual mental health functioning across follow-up appointments. METHOD: Data from 495 primary care patients (61.1% female, 60.7% Caucasian, 37.141 ± 12.21 years of age) who completed the Behavioral Health Measure (Kopta & Lowry, 2002) at each primary care appointment were used for the analysis. Three separate models were constructed to identify clinical improvement in terms of number of appointments attended, baseline impairment severity level, and the interaction of these 2 variables. RESULTS: The data showed that 71.5% of patients improved across appointments, 56.8% of which (40.5% of the entire sample) was clinically meaningful and reliable. Number of appointments and baseline severity of impairment significantly accounted for variability in clinical outcome, with trajectories of change varying across appointments as a function of baseline severity. Patients with more severe impairment at baseline improved faster than patients with less severe baseline impairment. CONCLUSIONS: Patients treated within an integrated primary care behavioral health service demonstrate significant improvements in clinical status, even those with the most severe levels of distress at baseline.